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Work From Home Claim Adjudication Jobs (NOW HIRING)

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

The Jernigan Agency

WORK FROM HOME

Toledo, OH · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Wichita, KS · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Arlington, TX · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Saint Paul, MN · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Hope Hull, AL · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Sioux Falls, SD · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Decatur, GA · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Bend, OR · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

High Point, NC · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Cedar Rapids, IA · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Las Vegas, NV · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Blythe, GA · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Lake Charles, LA · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Fredericksburg, VA · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Washington, DC · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Shreveport, LA · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

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All JobsClaim Adjudication JobsWork From Home Claim Adjudication Jobs

Work From Home Claim Adjudication information

See salary details

$15

$36

$46

How much do work from home claim adjudication jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for work from home claim adjudication in the United States is $36.99, according to ZipRecruiter salary data. Most workers in this role earn between $31.49 and $42.79 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a work from home claim adjudicator?

To thrive as a Work From Home Claim Adjudicator, you need strong analytical skills, attention to detail, and a solid understanding of insurance policies or healthcare claims, often supported by relevant experience or certification. Familiarity with claims management systems, electronic documentation tools, and sometimes industry certifications like AIC or CPC are typically required. Excellent written communication, time management, and self-motivation are vital soft skills for remote work efficiency and collaboration. These skills and qualities are crucial for ensuring accurate claim processing, minimizing errors, and maintaining compliance in a virtual work environment.

What is the difference between Work From Home Claim Adjudication vs Work From Home Claims Processor?

AspectWork From Home Claim AdjudicationWork From Home Claims Processor
CredentialsInsurance or healthcare certifications, relevant licensesBasic insurance knowledge, customer service skills
Work EnvironmentHome office, computer-based tasks, detailed reviewHome office, data entry, customer interaction
Industry UsageInsurance companies, healthcare providersInsurance companies, third-party administrators
Job FocusAssessing and approving insurance claims based on policiesProcessing claims, data entry, customer support

Work From Home Claim Adjudication involves evaluating insurance claims to determine approval based on policies and regulations, requiring specialized knowledge and certifications. In contrast, Work From Home Claims Processors handle the data entry and customer interactions related to claims, focusing on processing and documentation. Both roles are essential in the insurance industry but differ in responsibilities and required credentials.

What are some common challenges faced by remote claim adjudicators, and how can they be addressed?

Remote claim adjudicators often face challenges such as staying organized with high volumes of claims, maintaining effective communication with team members, and ensuring data security while working from home. To address these, it’s important to establish a structured daily routine, make use of secure company-provided systems, and participate in regular virtual meetings to stay connected with colleagues. Leveraging collaboration tools and adhering to best practices for data privacy can also help ensure accuracy and compliance in your work.

What is a work from home claim adjudication job?

Work From Home Claim Adjudication jobs involve reviewing and processing insurance claims remotely. Claim adjudicators examine claims to determine their validity and ensure they comply with policy guidelines and regulations. These professionals work for insurance companies or third-party administrators, using specialized software to analyze documents, communicate with clients, and authorize payments or denials. Working from home provides flexibility while still requiring strong attention to detail, confidentiality, and knowledge of insurance policies.
More about Work From Home Claim Adjudication jobs
What cities are hiring for Work From Home Claim Adjudication jobs? Cities with the most Work From Home Claim Adjudication job openings:
What states have the most Work From Home Claim Adjudication jobs? States with the most job openings for Work From Home Claim Adjudication jobs include:
What job categories do people searching Work From Home Claim Adjudication jobs look for? The top searched job categories for Work From Home Claim Adjudication jobs are:
Work From Home Claim Adjudication jobs near you
Infographic showing various Work From Home Claim Adjudication job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 17% Part Time, and 4% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $76,935 per year, or $37 per hour.

Supervisor, Claim Adjudication Operations

Navitus Health Solutions, LLC

Remote

$63K - $76K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Navitus Health Solutions rating

7.0

Company rating: 7.0 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

261st of 481 rated business services

Job description

Company
Navitus
About Us
Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other.. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.
Pay Range
USD $63,927.28 - USD $76,900.12 /Yr.
STAR Bonus % (At Risk Maximum)
7.50 - Pharm, Supvr, AsMgr, SrCSEII, PrgMgr, SrPrgMgr, SrProdMgr
Work Schedule Description (e.g. M-F 8am to 5pm)
M-F 8am to 5pm
Remote Work Notification
ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.
Overview
Due to growth, we are adding a Supervisor, Claim Adjudication Operations to our team.
The Supervisor, Claim Adjudication Operations (CAO) ensures efforts are in alignment with the CAO team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members and pharmacies by accurately administering benefits. This role will plan, design, coordinate and align resources to support the daily activities of the team. The Supervisor, CAO role will work closely with their team to identify, recommend, develop, implement, support, and improve customer-focused solutions.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
  • Oversee roles within the Claim Adjudication Operations department to support accurate and timely configuration and data transfers of client hierarchy, benefits, and networks.
  • Provide superior customer service utilizing a high-touch, customer centric approach focused on collaboration and communication.
  • Outreach and collaborate with CAO customers/partners for day-to-day work and contribute to action plan creation.
  • Oversight of work on Kanban boards, meeting turnaround times and performance guarantees.
  • Run department Kanban board(s) and huddles, including sizing of work requests.
  • Resource assignment of day-to-day work, audits, and root cause analysis/CAP.
  • Perform 1:1s to elicit feedback from department associates, provide mentorship, discuss career development, address performance, and provide workload and project guidance.
  • Perform workforce management duties for direct reports, including, but not limited to, overtime needs, time out of the office and time tracking.
  • Apply soft skills toward team members and external stakeholders alike in understanding every point of view and coming to the table with good negotiation skills. Must have the ability to work with different personalities across all departments and understand their point of view to communicate accordingly.
  • Adhere to department level objectives to ensure alignment with division and company strategic initiatives.
  • Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
  • Other duties as assigned.

Qualifications
What our team expects from you?
  • Bachelor's degree or equivalent work experience is required.
  • 4 years of Navitus experience in an operations or leadership role, OR 4 years of external leadership experience, preferably with a strong background in operations, required.
  • Knowledge of one or more responsibilities as defined above is strongly preferred.
  • Professional PBM industry work experience is preferred.
  • Knowledge of applicable data privacy practices and laws is preferred.
  • Healthcare industry practices and HIPAA knowledge would be a plus.
  • Experience as a member of a multi-disciplinary team is a plus.
  • Understanding of human resource management principles, practices, and procedures would be a plus.
  • Participate in, adhere to, and support compliance program objectives
  • The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus?
  • Top of the industry benefits for Health, Dental, and Vision insurance
  • 20 days paid time off
  • 4 weeks paid parental leave
  • 9 paid holidays
  • 401K company match of up to 5% - No vesting requirement
  • Adoption Assistance Program
  • Flexible Spending Account
  • Educational Assistance Plan and Professional Membership assistance
  • Referral Bonus Program - up to $750!

#LI-Remote
Location : Address
Remote
Location : Country
US

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